Rehabilitation of the upper arm early after stroke: Video games versus conventional rehabilitation. A randomized controlled trial

Laffont, I.; Froger, Jérôme; Jourdan, C.; Bakhti, Karima; Dokkum, Liesjet E.H. van; Gouaïch, Abdelkader; Bonnin, H.-Y.; Armingaud, Philippe; Jaussent, Audrey; Picot, Marie Christine; Bars, Emmanuelle Le; Dupeyron, Arnaud; Arquizan, Caroline; Gélis, Anthony; Mottet, Denis

doi:10.1016/j.rehab.2019.10.009

Cited by 36 publications

(29 citation statements)

References 40 publications

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“…In addition, most recent reviews delimit their scope in technological terms by considering interventions based on the devices being used [ 11 , 12 , 18 ]. Some authors characterise comparison between studies using different devices as difficult [ 44 ]. However, a holistic overview of serious games, regardless of the technology used, is important in order to better understand their added value in UL rehabilitation after stroke.…”

Section: Discussionmentioning

confidence: 99%

Serious games for upper limb rehabilitation after stroke: a meta-analysis

Doumas

Everard

Dehem

et al. 2021

J NeuroEngineering Rehabil

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Background Approximately two thirds of stroke survivors maintain upper limb (UL) impairments and few among them attain complete UL recovery 6 months after stroke. Technological progress and gamification of interventions aim for better outcomes and constitute opportunities in self- and tele-rehabilitation. Objectives Our objective was to assess the efficacy of serious games, implemented on diverse technological systems, targeting UL recovery after stroke. In addition, we investigated whether adherence to neurorehabilitation principles influenced efficacy of games specifically designed for rehabilitation, regardless of the device used. Method This systematic review was conducted according to PRISMA guidelines (PROSPERO registration number: 156589). Two independent reviewers searched PubMed, EMBASE, SCOPUS and Cochrane Central Register of Controlled Trials for eligible randomized controlled trials (PEDro score ≥ 5). Meta-analysis, using a random effects model, was performed to compare effects of interventions using serious games, to conventional treatment, for UL rehabilitation in adult stroke patients. In addition, we conducted subgroup analysis, according to adherence of included studies to a consolidated set of 11 neurorehabilitation principles. Results Meta-analysis of 42 trials, including 1760 participants, showed better improvements in favor of interventions using serious games when compared to conventional therapies, regarding UL function (SMD = 0.47; 95% CI = 0.24 to 0.70; P < 0.0001), activity (SMD = 0.25; 95% CI = 0.05 to 0.46; P = 0.02) and participation (SMD = 0.66; 95% CI = 0.29 to 1.03; P = 0.0005). Additionally, long term effect retention was observed for UL function (SMD = 0.42; 95% CI = 0.05 to 0.79; P = 0.03). Interventions using serious games that complied with at least 8 neurorehabilitation principles showed better overall effects. Although heterogeneity levels remained moderate, results were little affected by changes in methods or outliers indicating robustness. Conclusion This meta-analysis showed that rehabilitation through serious games, targeting UL recovery after stroke, leads to better improvements, compared to conventional treatment, in three ICF-WHO components. Irrespective of the technological device used, higher adherence to a consolidated set of neurorehabilitation principles enhances efficacy of serious games. Future development of stroke-specific rehabilitation interventions should further take into consideration the consolidated set of neurorehabilitation principles.

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Section: Discussionmentioning

confidence: 99%

Serious games for upper limb rehabilitation after stroke: a meta-analysis

Doumas

Everard

Dehem

et al. 2021

J NeuroEngineering Rehabil

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“…22 A related issue is that clinical trials of UL rehabilitation technologies typically control for exercise dosage between treatment groups, in order to test whether interventions are as effective as dose-matched, conventional therapy. [23][24][25][26][27][28] This entails researchers imposing scheduled therapy sessions, while closely supervising and supporting participants. However, this confounds one of the main attractions of rehabilitation technologies: that is, the potential to increase exercise dose without additional cost or manpower.…”

Section: Introductionmentioning

confidence: 99%

Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care

Broderick

Almedom

Burdet

et al. 2021

Neurorehabil Neural Repair

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Background. One of the strongest modifiable determinants of rehabilitation outcome is exercise dose. Technologies enabling self-directed exercise offer a pragmatic means to increase dose, but the extent to which they achieve this in unselected cohorts, under real-world constraints, is poorly understood. Objective. Here we quantify the exercise dose achieved by inpatient stroke survivors using an adapted upper limb (UL) exercise gaming (exergaming) device and compare this with conventional (supervised) therapy. Methods. Over 4 months, patients presenting with acute stroke and associated UL impairment were screened at a single stroke centre. Participants were trained in a single session and provided with the device for unsupervised use during their inpatient admission. Results. From 75 patients referred for inpatient UL therapy, we recruited 30 (40%), of whom 26 (35%) were able to use the device meaningfully with their affected UL. Over a median enrolment time of 8 days (IQR: 5–14), self-directed UL exercise duration using the device was 26 minutes per day (median; IQR: 16–31), in addition to 25 minutes daily conventional UL therapy (IQR: 12–34; same cohort plus standard care audit; joint n = 50); thereby doubling total exercise duration (51 minutes; IQR: 32–64) relative to standard care (Z = 4.0, P <.001). The device enabled 104 UL repetitions per day (IQR: 38–393), whereas conventional therapy achieved 15 UL repetitions per day (IQR: 11–23; Z = 4.3, P <.001). Conclusion. Self-directed adapted exergaming enabled participants in our stroke inpatient cohort to increase exercise duration 2-fold, and repetitions 8-fold, compared to standard care, without requiring additional professional supervision.

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“…Since its release in 2013, the Kinect v2 (also known as Kinect One or Kinect for Xbox One, Microsoft, USA) has been widely used for rehabilitation purpose and has largely contributed to the rise of virtual reality in rehabilitation trials. Virtual reality with Kinect may be beneficial in improving upper limb function and activities of daily living when used as an adjunct to usual care (to increase overall therapy time) [12,13]. However, although the markerless and ease of use properties of the Kinect v2 facilitate its use in clinical routine, and its value for gait analysis has been documented [14], the validity of the Kinect for assessing upper limb kinematics after stroke remains to be tested.…”

Section: ) Backgroundmentioning

confidence: 99%

Validity and reliability of Kinect v2 for quantifying upper body kinematics during seated reaching

Faity¹,

Mottet²,

Froger³

2022

Preprint

Self Cite

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Background: Kinematic analysis of the upper limbs is a good way to assess and monitor recovery in individuals with stroke, but remains little used in clinical routine due to its low feasibility. The aim of this study is to assess the validity and reliability of the Kinect v2 for the assessment of 17 kinematic variables commonly used in the analysis of upper limb reaching in stroke. Methods: 26 healthy participants performed seated hand-reaching tasks while holding a dumbbell to induce a behaviour similar to that of a person with a stroke. 3D upper limb and trunk motion were simultaneously recorded with the Kinect v2 (Microsoft, USA) and with the VICON (OxfordMetrics, UK), the latter being the reference system. For each kinematic outcome, the validity of the Kinect was assessed with ICC, linear regression and Bland & Altman plots. Results: The Kinect assesses trunk compensations, hand range of motion, movement time and mean velocity with a moderate to excellent reliability. In contrast, elbow and shoulder range of motion, time to peak velocity and path length ratio have a poor to moderate reliability, indicating that these variables should be interpreted with caution. Finally, instantaneous hand and elbow tracking are not precise enough to reliably assess Cartesian and angular kinematics over time, rendering variables such as the number of velocity peaks and the peak hand velocity unusable. Conclusions: Thanks to its ease of use and markerless properties, the Kinect can be used in clinical routine for semi-automated quantitative diagnostics guiding individualised rehabilitation of the upper limb. However, engineers and therapists must bear in mind the limitations of the Kinect for the instantaneous tracking of the hand and elbow.

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Rehabilitation of the upper arm early after stroke: Video games versus conventional rehabilitation. A randomized controlled trial

Cited by 36 publications

References 40 publications

Serious games for upper limb rehabilitation after stroke: a meta-analysis

Serious games for upper limb rehabilitation after stroke: a meta-analysis

Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care

Validity and reliability of Kinect v2 for quantifying upper body kinematics during seated reaching

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